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目的探讨主动脉夹层的首发临床特点和内科治疗经验,以减少致命误诊。方法回顾性总结2003年1月至2010年6月本院收治的40例主动脉夹层患者的诊疗经过。结果 40例患者中以老年男性且有高血压病史为主,多在血压控制不良合并诱因刺激下发病。首发症状以胸痛为主,首诊正确率仅20%。接受内科治疗的患者中,总好转率为40%,无效自动出院的40%,死亡率20%。结论主动脉夹层是内科的极危急重症,但首诊误诊率高,在临床中碰到急起胸背部剧痛、伴有虚脱表现,血压下降不明显甚至升高、脉搏血压不对称或消失、主动脉瓣杂音的患者时要高度怀疑主动脉夹层。在稳定生命体征的前提下,快速进行床边心电图、胸片结合B超、D-二聚体、心肌酶谱等必要检查快速诊断,再视病情选择超声心动图、螺旋CT和或MR血管造影的检查组合明确诊断。在治疗上,一旦疑诊就要迅速进行以内科治疗为基础的综合治疗,根据患者病变特点结合家属意愿选择确定个体化的治疗方案。
Objective To investigate the clinical features and medical experience of aortic dissection in order to reduce the fatal misdiagnosis. Methods The clinical data of 40 patients with aortic dissection who were admitted to our hospital from January 2003 to June 2010 were retrospectively reviewed. Results Among the 40 patients, elderly men had a history of hypertension and mostly developed in response to poor blood pressure control. The first symptom is chest pain, the first diagnosis is only 20% correct. In patients receiving medical treatment, the overall good rate of 40%, 40% of invalid automatic discharge, the mortality rate of 20%. Conclusions Aortic dissection is a very critical critical illness in medical department. However, the rate of misdiagnosis in first visit is high, and acute pain in chest and back is encountered in clinical practice. The performance of prosthetic aortic dissection is not obvious or even decreased. The pulse pressure is asymmetrical or disappears, Patients with aortic valve noise should be highly suspected aortic dissection. In the stability of vital signs under the premise of rapid bedside ECG, chest X-ray combined with B, D-dimer, myocardial enzymes and other necessary tests for rapid diagnosis, and then depending on the condition selected echocardiography, spiral CT and or MR angiography The combination of the diagnosis of a clear diagnosis. In the treatment, once the suspected will be promptly based on medical treatment-based comprehensive treatment, according to the characteristics of patients with family members choose to determine the individualized treatment options.